Abstract：
To assess the anatomical relationships and variations in the pretracheal space and to guide tracheotomy procedures in a safe manner with image-based evidence.
A retrospective study was conducted on unirradiated patients requiring elective tracheotomies. Preoperative contrast-enhanced CT (CECT)/CT venography (CTV) was applied for an anatomical evaluation of the pretracheal region. Vascular morphologies were compared for three vessels: the anterior jugular vein (AJV), the innominate artery (IA) and the inferior thyroid vascular plexus (ITVP). The relationships between the thyroid isthmus and the 2nd-4th tracheal rings were also analyzed.
A total of 120 patients were identified, most of whom (n = 110, 91.7%) had head and neck squamous cell carcinomas. Patients with recognizable AJVs (n = 118) were divided into 3 groups: single-branch (n = 11, 9.2%), double-branch (n = 105, 87.5%), and multibranch (n = 2, 1.7%). In addition, IAs were categorized as low-bifurcation (n = 51, 42.5%), high-bifurcation (n = 40, 33.3%), platform (n = 27, 22.5%) and variant types (n = 2, 1.7%). Within the platform types, high-lying IAs (n = 15, 8.3%) might have interfered with the standard tracheal incisions due to possible IA-tracheal overlay. This interference was also related to the height of intraoperative tracheal incisions (rn = 0.364, P = 0.001). Within ITVPs, independent-trunk types were found in 71 cases (59.2%), while common-trunk types were found in 45 (37.5%). In addition, a low thyroid isthmus (suprasternal-isthmus distance <3 cm) was found in 83 cases (69.2%).
CT image-based evidence can prepare junior practitioners with important pretracheal anatomical information, thereby facilitating safer tracheotomy procedures. Our results shed light on vascular relationships for emergent tracheotomy.
A retrospective study was conducted on unirradiated patients requiring elective tracheotomies. Preoperative contrast-enhanced CT (CECT)/CT venography (CTV) was applied for an anatomical evaluation of the pretracheal region. Vascular morphologies were compared for three vessels: the anterior jugular vein (AJV), the innominate artery (IA) and the inferior thyroid vascular plexus (ITVP). The relationships between the thyroid isthmus and the 2nd-4th tracheal rings were also analyzed.
A total of 120 patients were identified, most of whom (n = 110, 91.7%) had head and neck squamous cell carcinomas. Patients with recognizable AJVs (n = 118) were divided into 3 groups: single-branch (n = 11, 9.2%), double-branch (n = 105, 87.5%), and multibranch (n = 2, 1.7%). In addition, IAs were categorized as low-bifurcation (n = 51, 42.5%), high-bifurcation (n = 40, 33.3%), platform (n = 27, 22.5%) and variant types (n = 2, 1.7%). Within the platform types, high-lying IAs (n = 15, 8.3%) might have interfered with the standard tracheal incisions due to possible IA-tracheal overlay. This interference was also related to the height of intraoperative tracheal incisions (rn = 0.364, P = 0.001). Within ITVPs, independent-trunk types were found in 71 cases (59.2%), while common-trunk types were found in 45 (37.5%). In addition, a low thyroid isthmus (suprasternal-isthmus distance <3 cm) was found in 83 cases (69.2%).
CT image-based evidence can prepare junior practitioners with important pretracheal anatomical information, thereby facilitating safer tracheotomy procedures. Our results shed light on vascular relationships for emergent tracheotomy.
摘要：
评估气管前间隙的解剖关系和变化，并以基于图像的证据以安全的方式指导气管切开术。
对需要选择性气管切开术的未照射患者进行了回顾性研究。术前对比增强CT（CECT）/CT静脉造影（CTV）用于气管前区域的解剖评估。比较了三种血管的血管形态：颈前静脉（AJV），无名动脉（IA）和甲状腺下血管丛（ITVP）。还分析了甲状腺峡部与第2-4气管环之间的关系。
共确定了120名患者，其中大多数（n=110，91.7％）患有头颈部鳞状细胞癌。可识别的AJV患者（n=118）分为3组：单支（n=11，9.2％），双分支(n=105，87.5%)，和多分支(n=2，1.7%)。此外,IAs被归类为低分叉(n=51，42.5%)，高分叉(n=40，33.3%)，平台(n=27，22.5%)和变异类型(n=2，1.7%)。在平台类型中，高处IAs（n=15，8.3％）可能由于可能的IA-气管覆盖而干扰了标准气管切口。这种干扰也与术中气管切口的高度有关（rn=0.364，P=0.001）。在ITVPs内,71例(59.2%)发现独立躯干类型，而常见树干类型在45例(37.5%)中发现。此外,83例（69.2％）发现甲状腺峡部低（胸骨上峡部距离<3cm）。
基于CT图像的证据可以为初级医生准备重要的气管前解剖信息，从而促进更安全的气管切开术。我们的结果揭示了急诊气管切开术的血管关系。
对需要选择性气管切开术的未照射患者进行了回顾性研究。术前对比增强CT（CECT）/CT静脉造影（CTV）用于气管前区域的解剖评估。比较了三种血管的血管形态：颈前静脉（AJV），无名动脉（IA）和甲状腺下血管丛（ITVP）。还分析了甲状腺峡部与第2-4气管环之间的关系。
共确定了120名患者，其中大多数（n=110，91.7％）患有头颈部鳞状细胞癌。可识别的AJV患者（n=118）分为3组：单支（n=11，9.2％），双分支(n=105，87.5%)，和多分支(n=2，1.7%)。此外,IAs被归类为低分叉(n=51，42.5%)，高分叉(n=40，33.3%)，平台(n=27，22.5%)和变异类型(n=2，1.7%)。在平台类型中，高处IAs（n=15，8.3％）可能由于可能的IA-气管覆盖而干扰了标准气管切口。这种干扰也与术中气管切口的高度有关（rn=0.364，P=0.001）。在ITVPs内,71例(59.2%)发现独立躯干类型，而常见树干类型在45例(37.5%)中发现。此外,83例（69.2％）发现甲状腺峡部低（胸骨上峡部距离<3cm）。
基于CT图像的证据可以为初级医生准备重要的气管前解剖信息，从而促进更安全的气管切开术。我们的结果揭示了急诊气管切开术的血管关系。
